A key issue in rural health care delivery is the provision of emergency medical services, particularly for trauma care. Little is known about the effects of the rural hospital emergency department, the elements of the time to definitive treatment, and the relative use of advanced life support (ALS) verses basis life support (BLS) trained ambulance personnel on the outcomes of patients suffering traumatic injuries in rural areas. The proposed project will use 1991 statewide ambulance trip report data from rural Georgia to address these issues. The project provides a multivariate statistical analysis of the likelihood of trauma survival, where survival is hypothesized to be related to trauma severity, several components of time from report of event to arrival at definitive treatment, and characteristics of prehospital and hospital providers. The analysis focuses particular interest on the effects of ALS vs. BLS prehospital providers; the times consumed in response, extrication, care at site, and transport; and the length of time at the rural hospital prior to transfer to a trauma center. The study will also describe the clinical and demographic characteristics of rural trauma patients, the types and frequency of prehospital services provided, and the types of hospitals used. The results will provide insight on the advisability of programs to promote the use of ALS personnel on rural ambulances and transport protocols for rural trauma victims.